Mycophenolate mofetil in refractory discoid lupus erythematosus – Case report and literature review

Carlos M. Nogueira, Department of Dermatovenereology, Unidade Local de Saúde de Braga, Braga, Portugal Joana S. Silva, Department of Pathology, Unidade Local de Saúde de Braga, Braga, Portugal Catarina Cerqueira, Department of Dermatovenereology, Unidade Local de Saúde de Braga, Braga, Portugal Miguel S. Ribeiro, Department of Dermatovenereology, Unidade Local de Saúde de Braga, Braga, Portugal Sofia Lopes, Department of Dermatovenereology, Unidade Local de Saúde de Braga, Braga, Portugal Celeste Brito, Department of Dermatovenereology, Unidade Local de Saúde de Braga, Braga, Portugal

Discoid lupus erythematosus (DLE) is a chronic autoimmune disease affecting the skin, often leading to scarring, dyspigmentation, and reduced quality of life. Although several first-line therapies are available, some cases remain refractory. We report a 53-year-old female with treatment-resistant DLE, presenting with cicatricial alopecia and plaques on the face, torso, and limbs. Histopathology confirmed the diagnosis. Conventional therapies – including corticosteroids, hydroxychloroquine, prednisolone,methotrexate, acitretin, and dapsone – failed to provide lasting control. Treatment with mycophenolate mofetil (MMF) achievedsignificant clinical improvement and stabilization over 15 months, with good tolerability. This case illustrates the challenges ofmanaging refractory DLE and suggests MMF as a potential therapeutic option. A literature review reveals limited yet encouragingevidence from retrospective studies and case reports supporting MMF’s efficacy in refractory DLE. Further scientific evidenceis needed to establish its role in clinical practice and guide treatment for patients with severe or treatment-resistant DLE.

Keywords: Discoid lupus erythematosus. Refractory cutaneous lupus. Mycophenolate mofetil. Autoimmune skin disease. Cicatricial alopecia. Immunosuppressive therapy.